Revenue Cycle

Important Medicare updates

Medicare Update for CAHs, April 4, 2012

CMS redesigns claims and benefits statement

As part of National Consumer Protection Week, the CMS Acting Administrator, Marilyn Tavenner, announced the redesign of the statement that informs Medicare beneficiaries about their claims for Medicare services and benefits.  The redesigned statement, known as the Medicare Summary Notice (MSN), will be available online and, starting in 2013, mailed out quarterly to beneficiaries. 

View the press release 

CMS announces initiative to reduce avoidable hospitalizations

On March 15, 2012 CMS announced the Initiative to Reduce Avoidable Hospitalizations among Nursing Facility Residents, a new effort designed to improve care for people living in nursing facilities who are enrolled in Medicare and Medicaid.

 View the certification letter

CMS updates I/OCE specifications

On March 9, CMS issued a transmittal that updates the specifications for the integrated outpatient code editor (I/OCE). 

Effective Date: April 1, 2012

Implementation Date: April 2, 2012

View the transmittal

OIG identifies $1.5 million in overpayments made to Brigham and Women’s Hospital (MA)

On March 21, the OIG released an audit report that said Brigham and Women's Hospital, located in Boston, did not fully comply with Medicare billing requirements for 219 of the 359 claims reviewed. The incorrect billing resulted in net overpayments totaling $1.5 million for calendar years 2009 and 2010. Overpayments occurred primarily because the Hospital did not have adequate controls to prevent the incorrect billing of Medicare claims and did not fully understand Medicare billing requirements. 

View the report

CMS issues transmittal to explain MCTRJCA changes to Medicare fee-for-service policies

On March 14, CMS issued a transmittal that explains how the Middle Class Tax Relief and Job Creation Act of 2012 (MCTRJCA) contains a number of Medicare provisions which change or extend Medicare fee-for-service policies. Specific changes to the payment files resulting from the MCTRJCA are effective March 1, 2012 and include:

  • the moratorium that allows certain pathologists and independent laboratories to bill for the technical component (TC) of physician pathology services furnished to hospital patients through June 30, 2012
  • the exceptions process for Medicare therapy caps
  • the continuation of the Medicare physician work geographic adjustment floor

Effective Date: March 1, 2012

Implementation Date: March 15, 2012 

View the transmittal 

CMS published Medicaid program eligibility changes in final rule

On March 23, CMS published a final rule that implements several provisions contained in the Affordable Care Act. The final rule codifies policy and procedural changes to the Medicaid and Children’s Health Insurance (CHIP) programs related to eligibility, enrollment, renewals, public availability of program information and coordination across insurance affordability programs. 

View the final rule

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